Citation

Maragkos GA, Papavassiliou E, Stippler M, Filippidis AS. J. Neurotrauma 2018; 35(22): 2605-2614.

Affiliation

Beth Israel Deaconess Medical Center, 1859, Neurosurgery, Boston, Massachusetts, United States ; afilippi@bidmc.harvard.edu.

Copyright

(Copyright © 2018, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2018.5682

PMID

29877141

Abstract

Civilian gunshot wounds to the head (cGSWH) are devastating, but there is no consensus regarding prognosis and management. Therefore, we conducted a meta-analysis to identify prognostic factors associated with mortality. PubMed, EMBASE, Scopus, Web of Science and Cochrane Library were queried for retrospective cohort studies of isolated cGSWH reporting mortality prognostic factors. MOOSE guidelines were followed. Study quality was assessed using the Newcastle-Ottawa scale. Primary outcome was mortality. Pooled estimates of odds ratios and 95% confidence intervals were derived using random-effects models. 17 observational studies (1774 patients) were identified and included. Factors associated with mortality were: age >40 years (Odds Ratio 3.44; 95% Confidence Interval [1.71 to 6.91]), suicide attempt (5.78; [3.07 to 10.87]), GCS 3-8 compared with 9-15 (38.02; [21.98 to 65.77]), GCS 3-5 versus 6-8 (15.38; [6.72 to 35.23], bilateral fixed and dilated pupils versus normal (67.12; [16.67 to 270.22]), and versus unilateral fixed and dilated pupil (25.35; [5.82 to 110.41]), dural penetration (29.07; [4.30 to 196.53]), bihemispheric (4.23; [2.32 to 7.68]), and multilobar injuries (6.53; [1.99 to 21.42]). Selection for operative management, according to expert neurosurgical opinion, was protective (0.06; [0.01 to 0.22]). This is the first meta-analysis on cGSWH mortality prognostic factors. Increasing age, suicide attempt, lower GCS, bilateral mydriasis, dural penetration, bihemispheric and multilobar injury are associated with increased mortality. This study can serve as a guide to clinicians and will provide directions for future research to develop evidence-based management algorithms.

Language: en

Keywords

HUMAN STUDIES; Meta-analysis; OUTCOME MEASURES; Penetrating Ballistic-like Brain Injury; Penetrating Brain Injuries; Prognosis Gunshot Wounds.; SURGERY; TRAUMATIC BRAIN INJURY